An analysis by King’s College London has found that the NHS Cancer Drugs Fund (CDF) was not good value for patients and society, and may have resulted in patients suffering from toxic side effects of the drugs.
Money waste
The CDF was run between 2010 and 2016 at a cost of £1.27 billion. The research into the drugs approved for use by the CDF, recently published in the Annals of Oncology, found that only one in five treatments were beneficial to patients.
Looking at 29 drugs that had been approved for use through the CDF in January 2015 for 47 specific cancer conditions, the researchers found that only 18 (38%) of these indications were beneficial to patients in terms of overall survival according to clinical trials.
When the team consider other factors, such as quality of life and toxic side effects of the drugs, the majority of the CDF treatments failed to demonstrate any meaningful clinical benefit. In real-world situations also, the team stated that benefit was probably even less as clinical trial participants are carefully selected, with fewer health problems and younger in age.
“A ring-fenced drug fund was created despite a lack of evidence that prioritising drug expenditure would improve outcomes for cancer patients over and above greater investment in the whole cancer management pathway, which includes screening, diagnostics, radiotherapy, surgery and palliative care. We recommend that other countries that are considering similar ring-fenced drug access funds for high cost cancer drugs should adopt a more rational approach to funding high cost health technologies,” explained lead researcher, Professor Richard Sullivan from King’s College London. “Our finding underline the importance of reimbursement decisions for all drugs, procedures and interventions in cancer care being made through appropriate health technology appraisal processes. Only in this way will decisions be made on the best available evidence so as to maximise the value for cancer patients and society as a whole.”
A major failing of the programme was that no data on the outcome of patients who accessed the fund are available. Although data was supposed to be collected on the date of treatment cessation, side effects, deaths after 30 days of treatment and date of death or relapse, 93% of outcome data were incomplete. “We also lost a major opportunity to understand how these medicines work in the real world,” said Sullivan.
The CDF was closed in March 2016 due to it being financially unsustainable. A ‘new-look’ CDF came into force at the end of July 2016 and this provides managed access to new cancer drugs for a time-limited period in circumstances where the clinical and cost effectiveness of the drug is deemed uncertain according to national guidance.